NY Times: You WILL lose your Plan. You WILL pay more. You WILL stop complaining about it.

The NY Times editorial page this morning laid out some of the basic tenets of the Affordable Care Act: People will lose their plans, and they will pay more. An adjacent oped has an interesting view on those who complain about this.

Up to seven million people may be able to get health policies without paying any premium at all. Some four million people may have to pay more for new (and better) policies, not all of whom will necessarily be upset at getting better coverage at a competitive rate.

(At least) 4 million will not be able to keep their plan and "may have to pay more." This is just the individual market. The employer based market is much bigger and the disruptions to the employer market will be much larger as well. For instance, my small employer will be switching plans to avoid the Cadillac tax. The Cadillac Tax is a tax on high-price, high-benefit plans. The reason our old plan was a Cadillac plan is because we are a small company operating in NY. We have high premiums, but certainly not extravagant, not even generous, benefits. But such is the "logic" of the law that I must change to a plan with FEWER benefits for the purpose of..... If anyone can tell me I'd love to hear the answer.  The Affordable Care Act's response to their assertion American's pay too much for health care is to incentivice me from buying health care. Ok, but why? What if I want to buy health care? What's wrong with that? I like Apple products. An increasing portion of my budget over the years has gone to Apple products. But that's not a national crisis. I digress.

What was equally interesting to me was an op-ed by Lori Gottlieb remarking on the unsympathetic responses her friends had to her complaint about losing her plan and having to pay more for it.

“Obamacare or Kafkacare?” I posted on Facebook as soon as I hung up with Anthem. I vented about the call and wrote that the president should be protecting the middle class, not making our lives substantially harder. For extra sympathy, I may have thrown in the fact that I’m a single mom. (O.K., I did.)

 She wanted sympathy and instead was told to suck it up.

I understand the whole point of the law is to do this. The point of the law is to make some pay more and get less so others can pay less and get more. This whole Rube Goldberg contraption has that guiding principle. I do get that. But what the supporters of the law are finding out is that people get kind of cheesed when the foundational promises made when passing this law: keep your plan, keep your doctor, lower premiums, fewer uninsured, were deliberate deceptions, at worst, or made from ignorance of the law's consequences, at best.

Bill

Oh, and those heartless, evil, racist, stupid, insane, extreme neanderthals have been pointing out the law's promises were untrue for years. But tell me. If someone is a heartless, evil, racist, stupid, insane, extreme neanderthal for pointing out the truth, what is the person who has been deliberately deceiving or the person who didn't understand the untruths being promised?

Job Growth! Compliance is a Growth Industry

Daughter Knabe interviewed for a job in a compliance department. I encouraged her to drop this line on her prospective employers, "Compliance is a growth industry." What do you mean she asked?

This, from TheHill.com:

A growing thicket of federal regulations under the Obama administration has contributed to an employment spike in at least one corner of the job market: the increasingly vital compliance industry.

ObamaCare, the Dodd-Frank Act and other large federal undertakings have led to an outpouring of new agency rules derided by business groups and defended by advocates.

But the regulations have also been a boon for professional compliance officers paid to help companies understand and adapt to the new requirements. 

“Staff to track compliance issues is on the rise, and it has been for the last several years,” said Richard Riese, senior vice president for regulatory compliance at the American Bankers Association. “And, at the moment, there’s no prospect it will decrease anytime soon.”

Data kept by the Bureau of Labor Statistics (BLS) shows an 18-percent increase in the number of compliance officers in the United States between 2009 and 2012, according to an analysis conducted by the conservative American Action Forum (AAF).

Of course,  laws and regulations aren't necessarily bad. And of course many laws and regulations are necessary. But as we ask ourselves why is it that job growth remains anemic (except during periods when the government shuts down) maybe the answer can at least partly be found in increased regulatory burdens. 

Bill

The Affordable Care Act and Marriage

Turns out the Affordable Care Act has a fairly substantial incentive to avoid marriage. From The Atlantic

Any married couple that earns more than 400 percent of the federal poverty level—that is $62,040—for a family of two earns too much for subsidies under Obamacare. "If you're over 400 percent of poverty, you're never eligible for premium" support, explains Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation.

But if that same couple lived together unmarried, they could earn up to $45,960 each—$91,920 total—and still be eligible for subsidies through the exchanges in New York state, where insurance is comparatively expensive and the state exchange was set up in such a way as to not provide lower rates for younger people.

Personally, I don't care if people marry, who they marry, how many they marry, how often they marry, what species they marry. Personally, I don't think the government should care either.

I'm guessing this marriage penalty was not contemplated by the authors of the ACA. Designing "a system" sounds so alluring to those in power, and pretty much impossible to do in practice. We are seeing that proven (again) with the ACA.

Let's add this incentive to the long list of perverse incentives (employer incentive to reduce work hours, employer incentive to keep business from hiring, employee incentive to not work, consumer incentive to cost shift to Medicaid, insurance incentive to drop plans and of course insurance incentive to undo the risk pools so painstakingly created by the ACA). It is an edifice doomed to collapse. We've known this from the beginning.

Bill

Losing your Plan is a Feature, not a bug, of the Affordable Care Act

Supporters of the Affordable Care Act (ACA) respond to the "You can keep your plan" broken pledge by saying 1) those were junk plans that are being lost and 2) it only applies to small segment of the individual health care market. Both claims are wrong.

It is curious supporters would make a blanket claim about the quality of plans being dropped, a claim without subtlety and nuance, when it is exactly that lack of specificity that has put the broken pledge of "read my lips you can keep your plan" in such focus. The idea that ALL plans impacting 26 million people are junk is absurd on its face and there is no evidence presented ALL, or the majority, or even some, of those plans are junk.

The claim that losing your plan only applies to a small segment of the population is more troubling. There is plenty of evidence from HHS and CBO that many in the employer-based market will lose there plan. For instance, here is the CBO in May of 2013 estimating 7 million will lose employer based coverage by 2018 and 5 million total in the non-group market by 2017. That's a  lot of junk plans.

Casey Mulligan thinks the estimates are too low. He thinks the number can be 20+ million, driven by the incentives written into the law. Employers have an incentive to drop coverage and employees will have an incentive to allow their coverage to be dropped. He concludes:

Moreover, this is not an issue of the adequacy of the group coverage that's lost, it simply that the ACA induces market participants to tolerate coverage loses in order to, at taxpayer expense, reduce the monetary loses they experience as a consequence of the law.

Losing your health insurance is a feature of the ACA. The ACA was designed to kick people off their plans. This is not a surprise to many who have opposed this plan from the start.

Bill

Did Diane Feinstein Really Say "You can keep you plan" only applied until ACA was passed?

The answer Senator Feinstein gave to Bob Schieffer's question, on Sunday's Face the Nation,  about keeping your plan was that it applied only until the ACA was passed. Let's give her the benefit of the doubt that she was really answering some other question. But what question was she answering?

More and more people are discovering that losing your health plan is a FEATURE of the ACA, not a bug.

SCHIEFFER: The president said in the beginning that one thing was that if you like the health care program you had you could keep it. We now know there was debate within the administration before he said that as to whether that was actually a promise that could be kept. Should the president not have made that statement?
FEINSTEIN: Well, as I understand it you can keep it up to the time -- and I hope this is correct, but this is what I've been told -- up to the time the bill was enacted, then after that it's a different story. I think that part of it, if true, was never made clear. It is really very unclear right now exactly what the situation is. And, yes, that's a problem. But I think it has to be said, this is a very large major priority. And if it can get up and running, it can be, I think, a very positive thing. The big problem here is there are so many destroyers -- in the House, in the public, in the private health care sector that just want to destroy. That's not helpful.

Bill

When Are the Democrats Going to Suggest a Health Plan of Their Own?

1- Dems are upset Republicans didn't support the Affordable Care Act even though the ACA was a Republican idea, thought up by the Heritage Foundation and implemented in Massachusetts by Mitt Romney. Got it? The Affordable Care Act is a Republican idea.
2-Dems are upset the Republicans won't suggest a replacement for the Affordable Care Act. Got it? The Republicans have no ideas for health care.

But if #1 is true, number #2 is false, since the ACA IS a Republican idea.

So the real question is, When are the Democrats going to suggest a health plan of their own? And if the answer is Medicare for All, the question is, Why didn't they pass that in 2008 instead of passing the opposition party's plan?

Bill

Don't Spit on My Boots and Tell Me It's Rain. ObamaCare Edition

From CBS News:

(CBS News) WASHINGTON - For 31 days now, the Obama administration has been telling us that Americans by the millions are visiting the new health insurance website, despite all its problems. 

But no one in the administration has been willing to tell us how many policies have been purchased, and this may be the reason: CBS News has learned enrollments got off to an incredibly slow start.

Early enrollment figures are contained in notes from twice-a-day "war room" meetings convened within the Centers for Medicare and Medicaid Services after the website failed on Oct. 1. They were turned over in response to a document request from the House Oversight Committee.

 The number that signed up the first day? 6. As in 1, 2, 3, 4, 5, 6. Not six hundred, or six thousand. VI.

Now I know it's the tendency of most humans to hide bad news, and put the shiniest happiest face on things.

But as they say in Texas, Don't spit on my boots and tell me it's rain.

Bill